Interviews were conducted in December 2012 to understand if anything had changed since 2010 when complaint was submitted to the Special Rapporteur in 2010 with regard to the alarming situation with Tuberculosis treatment in HIV positive drug dependent patients in the Tuberculosis clinic in Yekaterinburg, located at 620050, Yekaterinburg, Kamskaya st., 37.

These interviews were attached to the another complaint to the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health which was submitted in March 2013 as a follow up to the previous complaint.

You may find more information about the situation in this clinic in 2010 here

Interview with a former patient of the Kamskaya clinic who underwent treatment there in 2009-2010 and took part in a collective complaint, a man slightly over 40 who came to the clinic with HIV, TB and after a stroke. (The patient is coded as M7)

M7: “I spent about 2,5 months in the emergency clinic, I couldn’t function, one hand, one eye, almost couldn’t speak. For a long time I was the only person in our room who survived, he says. The emergency clinic is being populated, then two-three days and they’re all gone in bodybags… “Wanderer’s last path” – this is how I called [the hospital] ”.

Comment from AD: Ill treatment of patients by the personnel. My interviewee stresses that he was treated well, explaining this by the fact that he was drug- and alcohol-free while in hospital and that he demonstrated a desire to recover.

М7: “But they guys got kicked out for insignificant violations. Taking the elevator while it’s prohibited to use the elevator to the dining room, only the stairs. Fat staff used the elevator, and those people who had to hold on to each other just to stand on their feet, had to use the stairs. If you used an elevator you’d be kicked out in 15 minutes. Not possible. Same if you had open tuberculosis; it wasn’t important if you just entered treatment a day or two before, if you are bedridden. They get you up and take you away, go… But I couldn’t understand that at all. A guy can’t walk, why can’t he use the elevator to the dining room? He can hardly get to the elevator. [The doctors said], our elevator is not working properly, it’s old.”

Comment from AD: New patients had to sign a pledge to avoid violating the treatment regime. Yet such violations could be staged by the personnel:

М7: “I personally saw them do that. If someone is not suitable for whatever reason, for just being rude, or they just plant a syringe in your bed. I personally saw that. They call witnesses – and you’re a junkie, that’s it. They just remove you. You’re rude, that’s it… There’s a woman there, a doctor… She doesn’t just hate the patients, she hates people… You’d say hello to her and she’ll yell at you so a regular person wouldn’t even keep silent about that. So that would start a quarrel, and the people there, they’re not exactly high society.”

Comment from AD: After the row a patient would be dismissed from hospital (jumping ahead, I’ll say: this is still happening). My interviewee explained that he can somehow understand the personnel because of the difficult work conditions at the hospital. Nevertheless, he took part in signing a collective complaint to the Ministry of Health.

М7: “They kicked many people out [for the collective complaint]. Ok, so we signed it. Next day, I’m sleeping they get me up. Aren’t you fed properly? You always have meat on your table. Why did you sign? I said, it’s written here, it’s all true. I signed because it’s the truth. There aren’t any lies there! The food is good, thanks for the extra ration. Anyway, the issue was: either I reject the complaint or I leave. That’s how it goes. Many of the signatories just disappeared from the clinic.”

Comment from AD: Regime violations were the reason for punitive dismissal from hospital:

М7: ”There is a “sleep hour”. And you’re walking in the hallway? Gone! Smoking in the bathroom? Whoa! Elevator? Bang!”

Ivan Zhavoronkov, employee of Chance+ commented on the asymmetric “response by the administration” thus: “One week after the inspection it all got quiet, [the inspectors] left and they dismissed everyone who signed the collective letter. Maybe they chose people randomly but still they let us know, there were even such statements that the inspectors come and go but we’re still here.”

Comment from AD: Still М7 stayed and continued treatment.

М7: “They got dismissed and I stayed. There was no reason to dismiss me, and them also but they still got dismissed.”

Comment from AD: One more type of punishment for complaining was to turn off the heating system in winter (while this ostensibly was an unrelated incident, it was used to punish the patients).

М7: “It was winter, very cold, the heating system was turned off for two weeks. And they didn’t let us go home. After that riot of ours. “TB patients can’t take the streetcar to go to the city!” After the complaint, that is. And the people were all cold, all blue. That too happened… They didn’t pay for the heat. The city turned it off. How do I know? I learned from the chief doctor.”

Comment from AD: The gloomy atmosphere at the clinic provoked patients’ suicides, and that happened after the complaint.

М7: “That was early in the morning or in the evening, I don’t remember. It was so quiet. The nurses got all wound up. What’s happening? Two or three, just got sick and tired of the diseases, it’s hard to cope, tired of being ill, of the attitude, all of that, so they decided to quit. They overdosed. They saved one person, with two more gone. That happened before I left the hospital. They brought them heroin, they said goodbye, went to their room, and that was it.”

Comment from AD: Throughout our interview the former patient of the Kamskaya clinic was calm and spoke steadily, but when I asked him to characterize his treatment in one sentence, he became anxious and said abruptly: “Ask anyone who’s been there – it’s a total fuckup! Nothing more to say.” And he added, “I am not angry at the doctors, they treated me well. But what I saw was scary as hell.” Currently patients are allowed to go out for walks and the regime of isolation is not active, i. e. after temporary strengthening of the regime following the complaints the situation returned to the status quo.

Interviews withLyudmila Vins (LV) and Ivan Zhavoronkov (IZ)

LV. There are at least 50,000 people with HIV in Ekaterinburg and Sverdlovsk oblast, about one third of them also have TB. At least several thousand people may have open TB. Neither the clinic on Kamskaya, which is an oblast-level institution, nor the three clinics that just opened in the oblast have enough beds to satisfy the treatment demand. People have to wait for their turn for months. Some patients are dismissed from the clinic when they are not fully treated, and this is justified by “regime violations”. The main violation is the use of drugs and/or alcohol. To some extent the situation at Kamskaya is not unique. Other clinics being opened in the oblast also dismiss their patients for similar violations. Yet drug treatment for people with opiate withdrawal is absent. I won’t even mention substitution therapy with methadone or buprenorphine, and even tramadol which in theory is allowed is not available at the Kamskaya. Only analgin and dimedrol are used, and they are difficult to obtain. The personnel treats drug users with negativity and contempt. Paradoxically, they treat people who don’t use drugs while drug users are dying. However, drug dependent people are the majority of their patients. It would make sense to speak about the need to treat the triple pathology, that is, HIV+TB+drug dependency. Moreover, the idea of hospitalizing all TB patients is doubtful. Clearly this is an overload of the healthcare system and a shortage of beds (that’s why you have long waiting lists of those getting into treatment), and if substitution therapy was available it would be possible to organize integrated outpatient treatment of the triple pathology, while hospitalizing only patients with acute forms. However, there isn’t any discussion of this. Rather, what is being discussed is the possibility of making the clinic a closed facility where patients with TB will be isolated as socially dangerous people. Following the 2010 complaints there were talks in the oblast about creating a specialized facility for people with triple pathology, but that never went anywhere. Meanwhile the attitude towards stigmatized drug users at Kamskaya is extremely negative. All these violations create an impression that nobody gives a shit about these people, the sooner they die the better. They still take many bodies in black body bags down the stairs. When somebody dies they can’t remove their body with dignity. They put them in black bags and take them down the stairs. It’s a scary place. Even if a drug user is alert, if he can talk, he says: no-no, I’d rather go to another place, not to Kamskaya. The practice of TB treatment without paying attention to HIV also continues.

IZ.Somebody just had a two-month stay at Kamskaya. He had to wait three weeks for his turn. He had nowhere to live, he has a wife and two little kids. Now they admitted him. He came in with 70 cells, they’ve been treating him for TB for 2,5 months, they dismissed him with 40 cells. I don’t understand the purpose of such treatment. I witnessed appalling narcophobia that a woman working there demonstrated during a phone call. Police detained a man and accused him of Article 6.9 of the Russian Administrative Code – the use of drugs without medical prescription. He explained that he was undergoing treatment at Kamskaya. I tried to explain to the police that he had TB and HIV, and that he can’t be incarcerated, much less so for 15 days. The cops suggested calling the clinic to find out if he was actually a patient. So I called Kamskaya, don’t remember who I spoke too – was it a doctor or a nurse, but when she learned that he’d been arrested… Yet I talked to her on behalf of a cop. The things she said to me! Who’s to be treated, put him in jail, they should put them all in a ghetto and burn them! It was a healthcare worker who said that. As a result of such attitudes some patients are dismissed with open TB, with AIDS. It’s like they send them to Mars. Readmission is impossible. So when they release a person in such condition, that means they release them to die.

Comment from AD. Overall, according to LV and IZ, no significant changes have occurred at Kamskaya compared to the pre-2010 complaint period.

Interview at the Kamskaya clinic with three male patients (М1, М2, М3) and one female patient of middle age, formerly a drug dependent person (F)

AD. In the second half of a Sunday we went to the hospital wishing to get there during office hours when the patients are allowed to go outside. The three-storied building looks worn outside and is hardly visible behind bushes. On the grassy slope by the entrance, in front of the clinic’s fence I saw a dead rat belly up – this sight put me in a special mood. Upon entering Ivan Zhavoronkov and I saw a meagre man, his legs like sticks. He waved to Ivan as if recognizing him. We came closer. “Where are you going?” we asked him. “I’m having dinner” said he and disappeared in the bushes, thus adding an element of absurdity to the situation. Having put our gauze masks on we entered the hospital and got up on the second floor and entered one of the rooms. The patients there weren’t against the idea of talking to us, and we quickly learned there was a degree of dissatisfaction with how the personnel treated the patients.

F: Well so they suspect I have bone TB. She (a doctor by the name of Tatiana Alexandrovna, or TA, – AD) tells me I should stay in bed, shouldn’t leave. And immediately suggests that I go to a hospital across town to a doctor [a surgeon to confirm the diagnosis]. Otherwise stay here, she said, until October, he’ll come here in October.

Comment from AD: Overall, there were especially many complaints about said TA woman whose last name I couldn’t find out – for some reason nobody remembered it. A patient said:

М1: So when they all learned I had TB she [TA] said directly: that’s all, you’re disintegrating, you’re dead. Imagine this! How’s that possible? You’re dead, do you want treatment? I said, of course I do, what can I do… And she can just tell me directly in my face, not very politely. Same with the inspection, you know they check you in the morning. So she comes to me with a stethoscope. I don’t know why she carries it around. She doesn’t use it ever. She just comes in, “Well, how are you? Ok, I’m leaving.” Why did you come in the first place?

Comment from AD. It was TA who М7 spoke about as a doctor who provoked patients to become rude to her in order to have them dismissed without finalizing treatment.

М1: Don’t like it? Get your treatment at home! She’s moody too. When she’s felling well she’s ok. She’s kind with her patients. Someone spent a night outside, had asked for a leave but didn’t come back on time, he got dismissed for violating the regime. This can be done.

Comment from AD. This woman holds a lot of power at the clinic and her attitude towards patient plays a significant role in creating a hostile atmosphere there. Almost everyone I spoke to mentioned her and complained about her. The patients complained about hospital food:

F. The food is horrible of course. Especially for patients like us the food is bad.

М1. The soup is like water. If there’s a little bit of potatoes in there everyone’s happy.

Comment from AD. Patients have told us that although an infectious disease physician checks the patients sometimes and although they bring HIV therapy, the treatment of coinfections, and its effectiveness causes questions.

М2: Also there are no tests here. There’s just one test here – for cells. The rest of them are interesting to know but aren’t available. They don’t tell us about viral load. They don’t do biochemical cell tests, only liver tests. The infectious disease physician is inept, if you ask her special questions. If there’s anything serious she’ll maybe give you some advice, but what advice can she give? Go to the AIDS Center]!

AD. Do they provide psychological aid to patients, and is there a psychologist at the clinic?

М3: The psychologist recommended Komplivit [vitamins]. And two liters of water. So I’m drinking water, the guys are making fun of me. I’m just exchanging bottles.

Interviews with former patients with М4, М5, М6

М4: Well naturally I’ve heard there’s nothing there, they call this clinic the final destination. And there always aren’t any beds at Kamskaya. But when they released me they were supposed to have some commission, so they would prepare everyone and just release them… They still keep those who stay in bed, but those who can walk – they can see them moving, going to the dining room, everywhere [so they dismiss them].

М4 also describes the treatment of patients by the personnel as unfavourable, again stressing the already known woman: “On a weekend I asked to be dismissed, and said: give me the pills so I don’t skip my doses. And the director [the doctor known as Tatiana Alexandrovna] says, no, take all the whole dose for two days, all at once. It’s 40 tablets actually! Why would I do that? I had to leave [without my pills], skipped two days ”.

М4 as everyone else complained that the doctors don’t inform the patients about the course of treatment and about test results: “I didn’t sign up for an appointment with the infectious disease physician, because I [still] was taking TB therapy, so the time came for me to be released and they referred me to the infectious disease physician. I came to see her, she looked at the test results, we had to take tests monthly, and I did too, and I didn’t even know the results, nobody told me how many cells I had, nothing. We asked questions. [But I was just told:] everything is well with you! So the infectious disease physician told me, when you came you had 72 cells and now you have 40. I said, what? She said, you need to start therapy. I said, I’m about to be released. She said, well you have to go to the AIDS Center, to register with the infectious disease physician there, here’s the number, call them to register.”

Comment from AD: The clinic at Kamskaya only treated Tuberculosis, so they had similar problems two years ago and they still have them now. This particular patient’s health not only worsened after the “treatment” in the absence of therapy, but he’ll only get his therapy in a few months after going through all the necessary bureaucratic procedures. And this is typical, not an exception.

М4: The guys look like they want to [get treated], but that becomes boring. There’s nothing in the rooms. No electrical outlets even. There’s a common TV, a common fridge for 20 rooms. You [can] go outside for two hours, an hour of sleep [during daytime], then two hours there, watching TV, at five it’s quiet, and until seven, in summer until eight, it’s like prison and you can’t leave. The guys and I went to the store to get cigarettes and went to a smoking room… In terms of painkillers they only have analgin and dimedrol. But once they only had analgin. Not even dimedrol! I was not too bad, but guys over there, really, awful pain and stuff. They tell them: “Why do you moan and whimper?” Not all were like that, there were good nurses. I tell them, inject them [pain medication]. For instance, we are standing and watching a TV set and we hear that someone is yelling in a room. When we enter the room, it’s too bad, in the room 6, there are bed patients only. There is nothing for them. She: “What can I give you? There is no dimedrol, we have analgin only”.

Comment from AD: Therefore, there is no OST in the modern treatment standards, and there is no access to any opioid painkillers.

М4 About meals in the clinic’s canteen: “Cooked on water, all food was steamed… Once a month [we were given] split peas with meat, I remember, potatoes with tinned meat, that’s it. Cutlets or chicken were tiny [very small, half palm size], about 50-100 grams. They gave us something. How much [food] a patient is supposed to get? If somebody asked for more food, they would give more only if something is left. What would be left there? Tiny portions. Is this nutrition? Had two bites of meat. Buckwheat on water. And fish! They kept feeding us pollack for a whole month, it was probably dried up, expired, I guess, I do not know. Bean soup – just beans, no potatoes. Beat or cabbage soup – a mere name – it was mostly water. … Patients there were treated badly. Physicians, nurses, they do not treat us as human beings. Not at all. They treat us as some pigs. Whatever we are, but we are human beings nonetheless. This person is an alcoholic, the other one is a drug addict, but at the moment he is a sick person, why would one yell at him? It is a separate issue – frequent deaths and the lack of respect for deceased. Once somebody died, they call for a catafalque, a grey GAZ car arrives, they take a black bag, open it up, and through the body in, close it and carry it out. As if it’s a garbage bag. No difference at all. How many [people died] while I was there? And this girl, she was alive in the morning and died by the lunch time. My first room mate, they kept pumping liquid out of his lungs, I do not know what was happening to him, but he became all swollen, probably because of his liver – that’s it he died. Then another a young guy, he was taking HIV therapy, then started taking TB drugs, I do not know for how long, for about a month he was in the clinic and then died. I do not know why, may be because of the TB treatment, he could not cope with it, doses were huge, he turned all yellow and fell into a coma. On Monday we were chatting, on Friday he dies. All happened so quickly. A lot of people die there … In the room # 6, there was a red headed guy, he also fell into coma, his sister or wife came to visit him, I do not know who she was, he was dying, in his bed, the head ward physician called for an IV, but it was too late, the guy is a corpse. Recently I called a woman I know, there in the room # 6 there was one, he kept smoking a pipe, he also had liquid in his lungs, they kept pumping it out, his legs became weak, he could not get to the bathroom, kept falling, spelt a bottle, went there, but could not get to the bathroom. Then he went to bed already in the room. So, she is telling, she went to the bathroom, that during the night and she heard him yelling in the room, nurses are not coming, nothing, nobody. He was throwing something, may be house slippers, to attract attention, about 4 am it was. Then she said that she thought he fell asleep. In the morning, that is it, he died. [Thebody] got cold. As I have been saying the attitude is like that: does not matter what and who a person was, if he or she makes it – good for him/her, who will not make it – bad for them. That is their logic there.

М5: Attitudes of doctors toward patients – to put it mildly – they treated us like dirt. I saw a great number of deaths there. My wife carried me in there on her arms. At my height, I weighed 30 kg. Skeleton, real skeleton. Rattlebones…. People call this clinic the “final journey”. All call it this way. They do no think what they are taking about – what this really means … So, doctor’s ward round is at 9 am. The attending physician entered [the room], looked at me briefly and told me directly that I have no chance [of surviving]. Of course, I remember this moment very well.

AD: You had TB associated with HIV, correct? Did you receive therapy [for these diseases] and what medical specialists at the clinic did think about this?

М5: The doctors did not give a damn whether I am taking HIV therapy or not. One pill needed to be stored in a fridge, and I was incapable of doing anything and could not walk to the fridge to take the pill at 9 – I take it twice at 9 am and 9 pm. I had no strength at all. My wife had agreed with this elderly guy [a neighbor in the room], he went to the fridge to get the pill, doctors did not help]… [The doctors did not gave any information to] me or my wife or close relatives. I kind of found myself in a position where I really was scared that I will not be able to get out of there. [There was no talking about the course of treatment. The doctors did not tell anything, about how TB and HIV treatments work together.] … When I started to feel better, I began to go out of the hospital for a walk, and was going to a nearby church to get a plastic bottle [holy water] from a water source, and then returned to the hospital. Once at the entrance to the hospital I met Tatiana Alexandrovna [already mentioned above female doctor]. Seeing a bottle of water from the church’s [holy water] source she said: “Even God will not help you!”. She disliked me because I was curious. She did not finish my treatment. I was expelled [from the hospital]. First I thought that these are busy times for the clinic and they did not have enough space for TB patients. However now I think that they wanted to free the bed. I used [drugs] at the time. A nurse recorded me on her cell phone how I was sitting with my eyes closed and they immediately kicked me out of there… There everybody was using [drugs] before or after treatment. “You junkies will all die!” The attitude was as if we are not humans. For example, Tatiana Alexandrovna told me that she is fed up with me. I gained weight there because I had nutritious meals, my mother and wife [supported me], so, I gained 20 kg, and Tatiana Alexandrovna entering our room during ward rounds kept telling me openly: “When will you already screw up so that we could kick you out?” … As I am telling this, I started stammering for some reason, I think this is because of the strong negative psychological effect [still painful] … Once I woke up, had my breakfast, stand there waiting for an elevator, the elevator door opens and this bagful falls out right on me, they drag it to a catafalque and left. Later you stop fearing this. You get used to it. In the evening we are sitting, smoking and chatting together in a smoking room, the next morning, you learn that this guy died.

М6: “It seemed to me that these people [physicians] there are professional, but as the time went I realized that they do not care [about their work with patients]. Maybe, they are professionals, I do not argue, but their attitude toward patients is rather clod. I have been analyzing and thinking and concluded that they kept me in the clinic until I started feeling better and then kecked me out of there … Someone’s pain and suffering do not touch them. Especially, if a person feels persistent pain and keeps asking [for pain killers]… Everyone was saying that the summer is a calm season. During the time when I was still in the ward, one person died. I was on the third [floor], and on the second people kept dying.

Interview with medical specialists A.D.

Comment A.D. The text below is based on the interviews with a drug treatment specialist (narcolog) (the interviewee did not allow recording the interview), an infectious disease physician from the AIDS center (interview recorded, the interviewee requested confidentiality) and the former psychologist at the Kamskaya clinic (the interviewee not allow recording the interview, transcripts were made based on the memory).

Drug treatment specialist (narcolog): In the Kamskaya clinic all problems caused by staff who do not want to ensure proper conditions for patients and establish atmosphere that would be good for patients and their treatment. In the clinics where staff wants to do so, as for example in the clinic where I work, everything works well.

CommentA.D. To prove what he was saying he showed us the ward after the interview. We observed clean rooms and spaces that are taken care of, patients looked fine, and we saw a nurse who was kindly helping a female patient to walk-up the stairs to the second floor; the patient has difficulties walking upstairs.

Drug treatment specialist (narcolog): Problems are also associated with the quality of the TB Service in the Sverdlovsk Oblast. Nobody wants [to treat] drug dependent people, except the Narcology (drug treatment) service. We tried to establish contact with medical specialists in the Kamskaya clinic, we visited [patients] there several times, but they stopped calling us. This situation cannot be changes without an order from above. After the previous complaint, a meeting, with participation of TB therapists, HIV specialists and drug treatment specialists was organized; it was agreed that we should cooperate. However, the Kamskaya clinic called us only once… In Sverdlovsk oblast and Yekaterinburg medical services are lagging behind. For instance in St. Petersburg, where traditions of Semashko are still alive, there are clinics where triple pathology is being treated: HIV+ TB + drug dependence. They do not expel their patients with untreated TB from clinics for regime violations.

Comment A.D. In the end of the interview the drug treatment specialist stated that this is his personal view and warned us that if we anywhere mention his name and position he will have to deny that he provided this information. The same situation was during the meeting with the Infectious Disease Physician from the AIDS center. As I understood, the fact that she allowed recording our interview was a generous gesture on her side and a sign of openness, if not freethinking.

Infectious Disease Physician: Now in the Kamskaya clinic we have an in-house Infectious Disease Physician (this was not the case before the complaint submitted in 2010). In all cases, the epicrisis that she writes for a patient who needs treatment or receives HIV treatment provides brief but complete information about the diagnosis, latest test results, and unwanted [side] effects, if these side effects were caused by the therapy. She examines our patients once a week, and some patients – once a month, she performs a complete medical check-up. I am not satisfied with the work of the TB therapists. They have no interest in two infections. There are in-patient clinics where TB therapists who treat TB pathology at least notices and pays attention to the associated HIV infection or a pre-existing. However, here [at the Kamskaya clinic] this is not the case at all. And if a patient experiences side-effects due to the treatment, we have to wait for the infectious disease physician to come and examine the patient, to analyze, while the TB therapist is there every day and he/she should examine the patients… No relations are established between doctors and patients over there. No relations at all are established between us [AIDS Center] and their TB therapists. If two medications cause side effects – that is TB and ours [ARVT] – then they cancel HIV therapy. These side effects may be caused by the immune reconstitution syndrome, this is a typical reaction. While patients require medical assistance in this situation, it is easier for them [medical specialists at the Kamskaya clinic] to cancel this medication and everything becomes calm and clear. ARVT cancellation worsens their [patients’] health condition. Leaving the patient untreated. Patients are not receiving treatment. This is why they are leaving the clinic with 40 cells. These problems are rooted in personal attitudes of the medical staff to their work and patients that can be formulated as follows: “why should we treat and care for you, if you die soon”. Mortality rates at the Kamskaya clinic are higher than in other clinics of the same profile, and the overall negative atmosphere contributes to the low quality of treatment… For example, just recently, a patient was told that he will not survive, and he has such form of TB that he does not need treatment and let’s wait until he dies. The patient’s father was trying to make doctors act, he went everywhere, he came here, bought medications, visited his son every day in the clinic and I do not know how, but he made them treat his son. And his son was released from the clinic. He was treated successfully. Everything worked out well for him. [They tell patients negative things] from the very beginning. And this is the most dangerous thing, as there are no possibilities to pull a patient out of there.

Comment A.D. We also had a conversation with the former psychologist at the Kamskaya clinic, who participated in the submission of the complaint to the Special Rapporteur and in the press-conference in 2010. The psychologist was fired from the clinic with labor legislation violations, and for two years he was in litigation with the clinic administration defending his rights. He was literally ostracized by his colleagues. Following the orders of the chief clinic staff all other staff members stopped talking to him, bringing the patients’ journal to his cabinet, changing his doctor’s gown. He was shaking remembering whose times we had our conversation. He said that when a TV crew came to the clinic in 2010 to make a reportage, they had to talk to the patients through the windows and the female-doctor (whom we already know well) fussed around pushing the patients away from the windows. According to the former psychologist, the situation at the Kamskaya clinic is the issue of the position taken by the administration of the clinic, they do not want to change anything. At the same time he thinks that partially behavior of staff can be explained by the fact that thy have to work with various difficult groups of patients, including people who served time in prisons and drug addicts. He says that food served in the clinic is absolutely normal what contradicted information provided by the patients.